34 The EastAfrican OUTLOOK MARCH 29 - APRIL 4, 2014 S CI E N C E Is a mammogram worth having Expe≥ts say that two-thi≥ds of women who a≥e destined to die of b≥east cance≥ will still die of it — even if they get high quality mammog≥ams By CHRISTE ASCHWANDEN Special Correspondent A scientist conducts a cancer test. Picture: AFP Cance≥ ≥esea≥che≥s studying HIV d≥ug By CHRISTABEL LIGAMI Special Correspondent RESEARCHERS from Kenya and Britain this month announced a medical breakthrough in the treatment of cervical cancer. The researchers said that they had discovered a cure for the early stages of the cancer using a commonly used HIV drug, Lopinavir. The study trial took place at the Kenyatta National Hospital in Nairobi, where 40 women with low-grade and high-grade stage pre-cancerous disease of the cervix were examined. The findings are to be presented at two conferences later this month. But doctors say the drug can only be effective at the early stages of cervical cancer. “The drug will only be of help if women are diagnosed early,” said Peter Gichangi, a consultant gynaecologist at Kenyatta National Hospital and lecturer University of Nairobi. “Women should therefore take pap smears at least once a year.” Lopinavir is available in cap- sules, tablets and oral solution. The researchers from the University of Manchester and KNH prepared it into gel so that it can be applied directly to the cervix in pessaries. “In gel form, the drug can melt easily, faster and smear itself on the walls of the cervix,” said Dr Gichangi. Oraro Maranga, the lead researcher in Kenya and a consultant obstetrician gynaecologist at the KNH said that out of the six HIV drugs that were tested on the human papillomavirus (HPV) cells during the laboratory test, Lopinavir “The drug will only be of help if women are diagnosed early.” Peter Gichangi, a consultant gynaecologist at Kenyatta National Hospital showed 100 per cent efficacy levels due to its high concentration levels, which makes it kill the cancerous cells. But doctors say no drug can treat cervical cancer unless the researchers are targeting the pre-invasive stages of cancer (stage zero). Cervical cancer has four stages of development and can only be treated by surgery, biopsy, radiation and chemotherapy. “The treatment for most stag- es of cervical cancer includes surgery, such as a hysterectomy and removal of pelvic lymph nodes — with or without the removal of both ovaries and fallopian tubes — chemotherapy and radiotherapy” said Dr Catherine Nyongesa, an oncologist at KNH. “Depending on how far the cancer has spread, you may have one or more treatments. And you may have a combination of treatments. If you have a hysterectomy, you won’t be able to have children. But a hysterectomy isn’t always needed, especially when the cancer is detected early.” If cervical cancer is detected at stage one, she says, treatment is 90 per cent effective; at stage two, treatment is 65 per cent effective; at stage three, 50 per cent and at the fourth and last stage treatment is 15 per cent effective. According to experts, less than 7 per cent of cervical cancer patients in East Africa are getting the optimum treatment needed to eradicate the disease. Tanzania has the highest cer- vical cancer mortality rate in East Africa, with a death rate of 37.5 per 100,000 live births, and ranks third globally, followed by Uganda, which ranks fourth with a mortality rate of 34.9 per 100,000 births. Rwanda is third in the region and ninth globally, with a mortality rate of 25.4 deaths per 100,000 live births. Kenya is at position 13 globally, with a mortality rate of 17.3 per 100,000 live births. K nowing whether to have a mammogram — and when — became more confusing than ever last month, when one of the largest-ever mammography studies cast doubts on the test’s value. The study followed 90,000 women over 25 years and found that death rates from breast cancer were the same in women who got mammograms as in those who did not. Moreover, the study showed that one in five cancers found with mammography and then treated was not a threat to the woman’s health. That sounds like pretty resounding evidence against the test. Yet mammography advocates such as the American College of Radiology (ACR) immediately criticised the study, calling it “incredibly misleading” and “deeply flawed.” Mammography machines used in the study, the ACR says, were not state-ofthe-art and thus did not find as many cancers as the latest devices would have found. What is a woman to make of this? Is a mammogram worth having — and if so, when? “Mammography saves lives,” says Otis Brawley, chief medical officer at the American Cancer Society. “But it doesn’t save as many lives as the American people think it does... The best studies we have suggest that two-thirds of women who are destined to die of breast cancer will still die of breast cancer — even if they get high-quality mammograms.” Women contemplating wheth- er to get a mammogram need to understand two things, says Fran Visco, president of the Na- tional Breast Cancer Coalition (and a breast cancer survivor): First, the deadliest cancers may spread before they are detectable on even the best mammogram; second, some of the cancers that mammograms find will never harm you. Until we can distinguish harmless cancers from deadly ones, we are compelled to treat all of them. Thus, some women get surgery, chemotherapy and other treatments for cancers that would never have hurt them. The decision to have a mammogram or not comes down to this: How much potential for harm will you accept in exchange for a chance that your life will be saved? There are no absolute right answers, Visco says. Callbacks But here are some numbers to consider: According to an analysis published this month in JAMA Internal Medicine, for every 1,000 women age 40 who get an annual mammogram for 10 years, there will be 510 to 690 callbacks for something that isn’t cancer, 60 to 80 biopsies that do not show a cancer, up to 11 women treated for a cancer that would not have killed them and fewer than two women whose lives are saved. From 50 to 59, the figures are 490 to 670 callbacks, 10 to 100 unneeded biopsies, between three and 14 women unnecessarily treated for cancer, and fewer than four lives saved per 1,000 women. From 60 to 69: 390 to 540 callbacks, 50 to 70 unneeded biopsies, between six and 20 women uselessly treated for cancer, and up to 49 lives saved. “If you weigh the benefits Radiologist examining Senobright contrast-enhanced digital mammography. A recent mammography study has cast doubts on the test’s value. Picture: AFP and harms and decide to have a mammogram, that’s fine,” Visco says. “And if you make a decision not to, that’s fine, too. You don’t have to feel compelled.” To confuse matters further, two large studies have shown that monthly breast self-exams increase the number of suspicious lumps that are found, but do not reduce cancer deaths. The American Cancer Society updated its guidelines in 2006, stating that these exams are optional except for women who are at high risk of the disease. The solution is not to stop looking for breast cancers, but to look more strategically, says Susan Love, a breast surgeon, activist and director of the Dr Susan Love Research Foundation. The US Preventive Services Task Force recommends mammograms every other year High costs, lack of equipment pushing By SILVIA RUGINA Special Correspondent ANCILLE MUKABAGIZA remembers the day in 2007 when she was diagnosed with breast cancer. Never had she thought that a swelling under her arm could take her on such a long journey to fight for her life. A teacher and a mother of three, she was her family’s breadwinner, and the thought of dying and leaving them destitute was enough to send her in search of treatment. She researched and found out that cancer treatment in India was much cheaper than in East Africa and so she travelled to India where, after chemotherapy and radiotherapy she was given a clean bill of health in July 2012. Today, the 55-year-old is a member of the Conquer Breast Cancer Association, which supports breast cancer patients and survivors in Rwanda. The World Cancer Report 2014 re- leased by the World Health Organisation indicates that the cancer burden is growing at an alarming rate and calls for efficient prevention methods to curb the disease. The report indicates that more than 60 per cent of the world’s new annual cases occur in Africa, Asia and Central and South America. There are two cancer centres in Rwinkwanvu and Butaro hospitals in Rwanda. The Butaro centre is 90km from Kigali city in Burera district while Rwinkwavu is 102km from Kigali, Kayonza, Eastern Province. Partners in Health and the government support the centres to treat $3,000 The cost of radiotherapy at one of the oldest Indian hospitals